Understanding moral distress in home-care nursing: An interview study.

BACKGROUND: Moral distress is a far-reaching problem for nurses in different settings as it threatens their health. AIM: This study examined which situations lead to moral distress in home-care nursing, how and with which consequences home-care nurses experience moral distress, and how they cope with morally stressful situations and the resulting moral distress. RESEARCH DESIGN: A qualitative interview study with reflexive thematic analysis was used. PARTICIPANTS AND RESEARCH CONTEXT: We conducted semi-structured interviews with 20 home-care nurses in Germany. ETHICAL CONSIDERATIONS: The study was approved by the Data Protection Office and Ethics Committee of the German Federal Institute for Occupational Safety and Health. FINDINGS: Twenty (14 female and 6 male) home-care nurses were interviewed between April and August 2023 at their chosen location. The situations leading to moral distress were inadequate care of the person in need of care, not being able to protect one's health, extended responsibility for the entire care arrangement, work-privacy conflicts, and conflicts between the understanding of care or professional ethics and the performance and billing system. The nurses experienced moral distress as they worked alone and provided care in the patient's territory. Short- and long-term strains with destructive cognitions, negative emotions, physical symptoms, and health consequences were reported. They faced challenges in coping with moral distress on institutional and individual levels. CONCLUSIONS: In cases of tension between the service and billing system and the understanding of these nurses' care services, moral distress is unavoidable. Alternative forms of organization and billing modalities, such as payment by time and the expansion and refinancing of service, should be implemented. The latter relates to systematic case and ethics meetings. Further, a transfer of medical activities, such as the prescription of wound material to registered nurses, could prevent morally stressful situations and improve patients' quality of care.

Improved professional competencies and leadership in PhD-prepared nurses and doctoral students after participating in the cross-national and web-based Nurse-Lead program.

BACKGROUND: Doctor of Philosophy (PhD)-prepared nurses are expected to exercise leadership in their various roles. Therefore, European nurse scholars developed a cross-national web-based Nursing Leadership and Mentoring Educational (Nurse-Lead) program. PURPOSE: To evaluate changes in leadership practices, professional and research competencies as well as career development of PhD-prepared nurses and doctoral nursing students after participation in the Nurse-Lead program. METHODS: A pre-post-test evaluation was conducted. Surveys addressed leadership, professional and research competencies, and career development. Quantitative data were analyzed with descriptive statistics and paired sample t-tests. Content analysis was used for qualitative data. DISCUSSION: The 30 participants showed significant improvements in all leadership practices, professional competencies, and most research competencies. Participants reported increased confidence in decision-making, taking on new responsibilities, and becoming more visible within research teams. CONCLUSION: Web-based, international leadership and mentoring programs are promising tools for the leadership and professional development of PhD-prepared nurses and doctoral nursing students.

[Stress experience of teachers in nursing education: A qualitative survey]. / Belastungserleben von Lehrenden in der Gesundheits- und Krankenpflege.

Stress experience of teachers in nursing education: A qualitative survey Abstract: Background: Teachers in nursing operate in a special area of tension. In addition to the demands of teaching, stress factors arise out of the nature of nursing. Aims: The main question is how teachers in health care and nursing describe their professional stress experience. Supportive and stressful factors as well as coping strategies of the teachers should be identified and described. Methods: This is descriptive qualitative research. Twenty-six guideline-based telephone interviews were conducted with nursing teachers in northern Germany. After transcription these were subjected to qualitative content analysis according to 21-2Mayring (2015). Results: The teachers in nursing indicate varying degrees of professional stress. Main aspects are general conditions, high workload, misconduct and problems of students and cooperation with the collegial team and school management. The proximity to the professional field of nursing has both mitigating and reinforcing factors on the experience of stress. Conclusions: Stress experience is described by the teachers in the context of a lack of support and appreciation of professional performance. In order to maintain the high level of motivation and identification with nursing and the professionalization of nursing, and to ensure high-quality education, teachers need support in the form of solid personnel, material and space resources, as well as more visible recognition of their work.

Bessere Wissensaufnahme durch Kurzfortbildungen vor dem Spätdienst statt nach dem Frühdienst?

Better knowledge absorption of short training courses before late shift than after early shift? An observational study Abstract. Introduction: Further training for nurses on intensive care units (ICU) is obligatory, but there is a lack of short-term options of up to 15 minutes during working time. Currently data for optimal positioning of short-term further training courses for nurses in ICU is not available. Question: What are the effects of short-term further trainings before late shift compared to after early shift on the knowledge acquisition of nurses in ICU? In addition, further framework conditions and a final recommendation for the events should be determined. Methods: Data was collected as an observational study with one group of nurses who took part in a 15-minute further training course at the start of the late shift (VS) and another who attended these at the end of the early shift (VF). A self-created questionnaire was used. The Odds Ratio (OR) was calculated as primary outcome using three questions. Secondary outcome parameters like punctual participation of the nurses, but also a final recommendation behavior counted were determined using methods of descriptive statistics. Results: With a response rate of 98.59% (n = 420), the overall OR was 1.22 (95%-KI: 0.90; 1.64) in favor of the VS group compared to VF. 96.73% (n = 237) of nurses in group VS and 80.13% (n = 121) in VF were able to attend further trainings in time. Participants recommended the short training courses on a scale of 1 (definitely go) to 6 (prefer to stay) in VS with an arithmetic average of 2.27 (SD 1.15) and in VF with 2.21 (SD 1.07). Conclusion: Short further training courses should be offered at the beginning of the late shift.

Experiences with combined personal-online case management and the self-reliance of older people with multimorbidity living alone in private households: results of an interpretative-hermeneutical analysis.

BACKGROUND: To date in Germany, only few studies have been conducted concerning the efficacy of care and case management (CCM) for older people and about using communication technology during monitoring. AIM: With this study, it is intended to gain a better understanding of how CCM in general is perceived by older people (65+) living alone and in particular what they think about the CCM monitoring process used during video conferences. METHOD: The sampling and work cycle were based on the Grounded Theory. Two different subsamples (each n = 20; total sample: 70% women; age range: 64-92 years) were recruited. Interviews were conducted with the focus on CCM contributions (Subsample I) and monitoring supported by video conferences (Subsample II). All participants had received CCM from external providers (care support centres) in two German federal states. The intervention of CCM ranged between four and twelve months. Participants of Subsample II received additionally moderated video conferences via tablet PCs for and with older people over an intervention period of nine months. RESULTS: Care and case management was experienced as a possibility for receiving individual support and for improving the user's everyday life. Within a short time, video conferences were a familiar communication tool. They enabled particularly people with reduced mobility to get barrier-free access to case managers, compensated for isolation and enabled participation. CONCLUSIONS: According to the view of older CCM users with multimorbidity living alone, CCM offers formative and organisational support in various life-domains. Combined with video conferences, the exchange of information becomes barrier-free and instantaneous, and the sense of security in health questions is reinforced.

Measuring attitudes towards interprofessional learning. Testing two German versions of the tool "Readiness for Interprofessional Learning Scale" on interprofessional students of health and nursing sciences and of human medicine.

Objective: In order to verify the methodological quality of two versions of a tool for measuring attitudes towards interprofessional learning, we adapted - in terms of translation and scale form - the Heidelberg Version [1] of Readiness for Interprofessional Learning Scale - RIPLS [2], a methodologically controversial tool that had been translated into German, and compared both the original and new versions. Method: Three items were reworded and the scale form altered (from five to four levels), leading to the Halle Version that was validated by means of a cognitive pretest (n=6). Both questionnaires were completed by students taking the interprofessional degree program in Health and Nursing Sciences (HNS) and by students of Human Medicine. The test quality of both tools was examined by analyzing the main components and reliability using the scales allocation of the items as according to Parsell and Bligh [2]. Results: The questionnaires were randomly assembled and distributed to 331 students. The response was n=320 (HNS n=109; Medicine n=211). The Halle Version "RIPLS-HAL" of the questionnaire was completed by n=166 and the Heidelberg Version "RIPLS-HDB" by n=154. In the main component analysis the data could not depict the scale patterns of the original Australian tool. The reliability values of both the Heidelberg and Halle versions were only satisfactory for the "Teamwork and Collaboration" and "Professional Identity" scales. Conclusions: The German version of the Readiness for Interprofessional Learning Scale has only limited suitability for recording the attitude towards interprofessional learning. The present versions can be regarded as an approach towards developing a more suitable tool.

[The development of an instrument for the "evaluation of hospices from the bereaved family members perspective"]. / Die Entwicklung eines Instruments zur "Evaluation stationärer Hospize aus der Perspektive hinterbliebener Angehöriger" (EHPA).

Inpatient hospice settings as facilities of health services are obliged to the quality assurance and internal quality development in Germany. The meaning of the patient's satisfaction as one of the indirect indicators for the judgement of nursing and care quality is indisputable by now. However, a subjective evaluation of the hospices by guests is practically and ethically problematic. An alternative approach is to investigate the views of bereaved relatives and close friends after the guest's death. The present article describes the development of an inventory for the evaluation of inpatient hospice settings from the bereaved relatives' point of view in order to examine the satisfaction of family members with the end-of-life care their loved ones received. With help of the inventory the question should be answered how family members judge the end-of-life care which was given to them and their late family members by the hospice. The construction of the questions results from the basis of existing concepts to the assessment of the end-of-life care and an analysis of all identified instruments to the evaluation of inpatient hospice settings from the perspective of bereaved relatives. The development of the questionnaire enclosed the formation of an item pool, the item choice, the critical discussion of the questions in the body of experts as well as a standardised and cognitive pretest beside a comprehensive literature research. A five-dimension questionnaire was developed that integrates physical, psychological, social, spiritual, and organisational aspects of the care at the end of life. The instrument encompasses 53 items, predominantly closed questions.

[IDAK--inter-professional documentation of lung cancer patients' information regarding their status in the hospital]. / IDAK--interprofessionelle Dokumentation der Aufklärung im Krankenhaus. Die Auswirkungen einer berufgruppenübergreifenden Dokumentation des Aufklärungszustandes von Bronchialkarzinom-Patienten auf die Anwesenheit des Pflegepersonals im Patientenzimmer.

UNLABELLED: The abbreviation IDAK stands for the documentation paper developed and tested during the project: Inter-professional Documentation of information (German: Aufklärung) in the hospital (German: Krankenhaus). OBJECTIVE: The aim of the IDAK project was to evaluate one documentation system for both medical and nursing staff about what the patients know regarding their diagnosis and prognosis. Accurate documentation of the patients' status of being well-informed should help to realize congruent communication by the nurses. METHODS: The case control study was undertaken with patients suffering from lung cancer; it aimed to show that nurses knowing about what the patients know, will be more confident in talks and stay longer at the bedside. After the descriptive examination the data were subjected to an explorative analysis. RESULTS: We collected data for 76 daily profiles in the intervention group and 69 in the control group (N=145). In the intervention group we could detect a significantly higher contact time per conversation (intervention group 2:46 min; SD 1:05; SE 0:07, control group 2:19 min; SD 0:40; SE 0:04; Mann-Whitney: p(0.05)=0.016). The result of this study shows how often and for how long it is possible for patients with lung cancer to exchange information with nursing staff, but the result is too poor for showing an effect of the IDAK documentation.

[Talk of enlightenment and information in the hospital]. / Aufklärungs- und Informationsgespräche im Krankenhaus.

The aim of this descriptive study was to identify the situation of conversation between hospital nurses and physicians and their patients about diagnosis and illness and to unweave the structure of communication in the interdisciplinary team that influences the personel's behaviour in the conversation. The rate of rebound in this postal debriefing amounted to 42 percent. 144 nurses from nursing and 46 medical staff participated. The examination showed that there are influencing factors, shown as formal (ward round, committing conversations, team conversations and documentation systems) and informal (colleagues and flair) structure of communication. In consequence of the non-homogenous structure of communication the hospital staff is not homogenous informed about the awareness of patients concerning diagnosis and illness. That's why hospital staff is without self-confidence in conversations with patients and avoids talks. Furthermore, a lack in teaching communication skills was revealed both in medical and nursing education and it became evident that nursing staff are not yet informed about juridical aspects of information talks. A documentation of patient's information status enables a congruent and authentic contact between staff and patient.